To lose weight or wait it out?

Who should lose weight, and who should "grow into" his or her weight"? A 13 year old girl who weighs 200 pounds will not grow into her weight because that weight is too high to be healthy unless she reaches 6' tall. Recommendations from a committee of experts, published in the medical journal Pediatrics, and currently under review, state that weight loss is recommended for overweight teens who have:

• a BMI in the 95th percentile or higher.
• a BMI from the 85th up to the 95th percentile if they have medical problems, such as high blood pressure, related to their weight.

However, for teens whose weight problems are less serious - that is, those with a BMI placing them from the 85th up to the 95th percentile and without weight-related medical problems - maintenance is recommended, because they can grow into their weight through physical activity and healthy eating. For young people in this category who are finished growing, gradual weight loss would be appropriate, according to Sarah Barlow, MD, a member of the committee.

What's a safe rate of slimming down for overweight teens who meet the criteria for a weight loss? Dr Barlow says, "I'm comfortable with a teen losing at a rate of one to two pounds per week. Losing faster than that may mean that the body will start losing too much muscle tissue along with the fat, and that's not healthy. If a teen's hungry all the time, that's another sign that a diet is too strict and weight loss is too fast."

The best way to find out whether an overweight teen should be losing weight or "waiting it out," according to the guidelines, is to check with a physician.

Choosing words for weight

Obese. Fat, Overweight. These words bring pain and shame to those so labeled.

"Obese" is a clinical term used to describe someone with excessive body fat tissue who is quite overweight. Because the word "obese" is considered stigmatizing, many weight experts shy away from it, particularly when referring to children and teens. Instead, they tend to use the word "overweight" to describe young people who would be considered medically obese. "At risk for overweight" is a common term for kids whom most people would consider to be overweight or somewhat overweight.

"Fat" has no standard medical definition, but it's commonly used to describe both obese and overweight people. It's preferred by some people who feel that the word "overweight" implies an "ideal" standard, when, in fact, a variety of weights can be healthy for individuals of a particular height.

For lack of a better term, we should generally use "overweight" to describe teens who would be considered medically overweight or obese, as does New York University's Sharron Dalton, Ph D, RD, in her book Our Overweight Children. Terminology aside, the important thing is for each teen to find a weight that's not only healthy for him or her but also realistic and comfortable to maintain.